Thromb Haemost 1996; 75(01): 076-082
DOI: 10.1055/s-0038-1650224
Original Article
Schattauer GmbH Stuttgart

Nafamostat Mesilate, a Broad Spectrum Protease Inhibitor, Modulates Platelet, Neutrophil and Contact Activation in Simulated Extracorporeal Circulation

Sumuk Sundaram
4   The Department of Chemical Engineering, University of Delaware, Newark, DE, USA
,
Nicolas Gikakis
3   The Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
,
C Erik Hack
2   The Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, The Netherlands
,
Stefan Niewiarowski
1   The Sol Sherry Thrombosis Research Center, Temple University School of Medicine, Philadelphia, PA, USA
,
L H Edmunds Jr
3   The Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
,
A Koneti Rao
1   The Sol Sherry Thrombosis Research Center, Temple University School of Medicine, Philadelphia, PA, USA
,
Ling Sun
4   The Department of Chemical Engineering, University of Delaware, Newark, DE, USA
,
S L Cooper
4   The Department of Chemical Engineering, University of Delaware, Newark, DE, USA
,
Robert W Colman
1   The Sol Sherry Thrombosis Research Center, Temple University School of Medicine, Philadelphia, PA, USA
› Author Affiliations
Further Information

Publication History

Received 31 March 1995

Accepted after revision 27 September 1995

Publication Date:
10 July 2018 (online)

Summary

Activation of humoral and cellular participants in inflammation enhances the risk of postoperative bleeding and multiple organ damage in cardiopulmonary bypass (CPB). We now compare the effects of heparin alone in combination with nafamostat mesilate (NM), a protease inhibitor with specificity of trypsin-like enzymes, in an extracorporeal circuit which simulates CPB. NM significantly inhibits the release of platelet (β-thromboglobulin (βTG) at 60 and 120 min. Platelet counts do not differ. ADP-induced aggregation decreases in circuits with NM, which is due to a direct effect of NM on platelet function. NM prevents any significant release of neutrophil elastase; at 120 min, plasma elastase-α1antitrypsin complex is 0.16 μg/ml in the NM group and 1.24 μg/ml in the control group. NM completely inhibits formation of complexes of C1 inhibitor with kallikrein and FXIIa. NM does not alter markers of complement activation (C1-C1-inhibitor complex and C5b-9), or indicators of thrombin formation (F1.2). However, at 120 min, thrombin activity as measured by release of fibrinopeptide A is significantly decreased. The data indicate that complement activation during CPB correlates poorly with neutrophil activation and that either kallikrein or FXIIa or both may be more important agonists. The ability of NM to inhibit two important contact system proteins and platelet and neutrophil release raises the possibility of suppressing the inflammatory response during clinical CPB.